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目的 评价肾细胞癌术后放疗的疗效和预后因素。方法 对90例无远地转移的手术后肾细胞癌患者进行回顾性分析。Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为2 7、18、35、10例。5 2例接受术后常规分割放疗(放疗组) ,采用前后野或侧斜野照射,中位剂量为5 0Gy。38例未接受术后放疗(手术组)结果 5、10年总生存率放疗组分别为75 %、6 0 % ,手术组分别为5 0 %、4 0 % (P =0 .0 0 0 )。放疗组和手术组Ⅰ、Ⅱ、Ⅲ、Ⅳ期5年生存率分别为10 0 %和6 7%、71%和5 5 %、6 5 %和4 7%、4 3%和0 %。局部复发12例中肾床3例,同侧肾门淋巴结6例,两者同时存在3例。手术组局部区域复发率为2 8.9% ,放疗组复发率为1.9% (P =0 .0 0 1)。放疗组和手术组Ⅲ期患者复发率分别为5 %、33%。放疗组中1例在放疗后1年出现小肠梗阻(保守治疗8年后手术解除梗阻)。Cox多因素分析提示淋巴结有无转移、卡氏评分、术后放疗、有无症状、术后残留是总生存率的预后因素。结论 放疗能减少肾细胞癌术后复发,尤其在Ⅲ期患者中放疗对局部控制率和生存率均有益处。放疗应选择复发危险大的患者,放疗计划必须合理设计。淋巴结有无转移、卡氏评分、术后放疗、有无症状、术后残留为预后因素。1997年的TNM分期比Robson’s分期更适于临床运用。
Objective To evaluate the efficacy and prognosis of postoperative radiotherapy for renal cell carcinoma. Methods Ninety patients with postoperative renal cell carcinoma without distant metastases were retrospectively analyzed. Ⅰ, Ⅱ, Ⅲ, Ⅳ were 2 7,18,35,10 cases. Fifty-two patients underwent conventional fractionated radiotherapy (radiotherapy group), with anteroposterior or lateral oblique irradiation, the median dose was 50 Gy. 38 cases did not receive postoperative radiotherapy (surgery group) Results The 5-year and 10-year overall survival rates were 75% and 60% in the radiotherapy group and 50% and 40% respectively in the operation group (P = 0.0000) . The 5-year survival rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ in radiotherapy group and operation group were 100% and 67%, 71% and 55%, 65% and 47%, 43% and 0%, respectively. Local recurrence in 12 cases of renal bed in 3 cases, ipsilateral kidney-node lymph nodes in 6 cases, both simultaneously exist in 3 cases. The recurrence rate in the local area was 2 8.9% in the operation group and 1.9% in the radiotherapy group (P = 0.010). The recurrence rates of stage Ⅲ patients in radiotherapy group and operation group were 5% and 33% respectively. One patient in the radiotherapy group developed small bowel obstruction 1 year after radiotherapy (operation was relieved after 8 years of conservative treatment). Cox multivariate analysis showed lymph node metastasis, Karnofsky score, postoperative radiotherapy, asymptomatic, residual postoperative prognostic factors of overall survival. Conclusion Radiotherapy can reduce postoperative recurrence of renal cell carcinoma, especially in patients with stage Ⅲ radiotherapy on local control rates and survival rates are beneficial. Radiotherapy should choose patients with high risk of relapse, radiotherapy plan must be reasonable design. Lymph node metastasis, Karnofsky score, postoperative radiotherapy, asymptomatic, postoperative residual factors for the prognosis. The 1997 TNM staging is more suitable for clinical use than Robson’s staging.